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PubMed1993

Neutralizing antibodies in 6-year-old children after five doses of tetanus toxoid.

It has recently been suggested that multiple boosters of tetanus toxoid may enhance serum antitoxin titres but may not necessarily lead to an effective immune response. Tetanus antitoxin titres by haemagglutination inhibition and mouse toxin neutralization tests were determined in sera of 64 children, 5 and 6 years old. Primary vaccination against tetanus was given as four doses of diphtheria-pertussis-tetanus (DPT) vaccine beginning in the second or third month of life, and a booster dose given to schoolchildren at 6 years of age. In our area more than 90% of children receive five doses of tetanus toxoid before their seventh birthday. The children were given 0.5 ml of DPT or DT containing 10 Lf ml-1 tetanus toxoid at each injection. The haemagglutination titres and the toxin neutralization titres were much higher in 6-year-old than in 5-year-old children. We concluded that the fifth dose is an effective booster in 6-year-old children.

Animals↗

PubMed2004

Missed opportunities for tetanus vaccination in pregnant women, and factors associated with seropositivity.

The aim of this study was to identify the seroprevalance rate of tetanus and to determine missed opportunities for tetanus vaccination. Two hundred and twenty-seven female volunteers who were hospitalized following delivery participated in the study. Blood samples were analyzed using enzyme-linked immunoassay to measure tetanus antibody levels. In addition, a questionnaire was used to investigate the factors associated with vaccination status. Sixty-five percent of the study participants had safe protective levels of antibodies. Factors associated with antibody level were age, level of education and number of doses. Only 25.7% of women who received antenatal care (ANC) had received tetanus vaccinations. Women who received ANC from primary healthcare facilities were more likely to have been vaccinated than those who received ANC from hospitals or private practice (P < 0.05). Factors associated with both tetanus vaccination and immunizations in pregnant women should be further investigated by qualitative and quantitative studies. Knowledge, attitude and practice surveys of mothers and healthcare providers on provision of the tetanus vaccine to pregnant women need to be undertaken urgently.

Adolescent↗

PubMed2004

Adult tetanus, diphtheria and pertussis immunization: knowledge, beliefs, behavior and anticipated uptake.

BACKGROUND: Lifetime protection against pertussis has been adopted as a goal of immunization programs in Canada. To anticipate adult coverage with a combined product containing tetanus (T) and diphtheria (d) toxoids and acellular pertussis (aP) vaccine as a booster dose, we conducted a survey of households in British Columbia, Canada. METHODS: In a random telephone survey involving 800 adults, 25 years of age and older, we assessed current behaviors related to adult Td immunization and beliefs regarding pertussis vaccine under various scenarios relevant to adult decision-making. RESULTS: Forty-five percent of participants reported having received tetanus vaccine within the previous 10 years; this rate was lowest amongst elderly persons 65 years of age or more (28%). On multi-variate analysis, being up-to-date with tetanus immunization was independently associated with belief that an adult should be immunized against tetanus and perception that tetanus is life-threatening and inversely associated with being elderly. At baseline, 59% of respondents indicated willingness to receive pertussis immunization if provided free; this increased to 76% following sequential information about communicability and severity of pertussis illness and safety, efficacy and convenience of vaccine and up to 87% if accompanied by physician or nurse recommendation. Sixty-three percent of adults indicated they would receive the vaccine if required to pay $40.00 (Cdn) for it. CONCLUSIONS: Personal risk perception, public funding and physician recommendation are important to adults when considering tetanus and pertussis immunization. These factors may be relevant as immunization programs are expanded to include more adults generally.

Adult↗

PubMed2001

Booster response to the tetanus and diphtheria toxoid carriers of 11-valent pneumococcal conjugate vaccine in adults and toddlers.

We measured the tetanus and diphtheria antitoxin responses after administration of one dose of a mixed carrier (tetanus and diphtheria toxoids) 11-valent pneumococcal conjugate vaccine (PncDT) in 20 Finnish adults (mean age 26.1 years) and 20 Finnish (mean age 23.2 months) and 23 Israeli (mean age 18.5 months) toddlers. The vaccinees had previously been immunised with multiple doses of vaccines containing diphtheria and tetanus toxoids. A double-antigen ELISA was used to measure the antitoxin concentrations. PncDT induced significant booster responses in both adults and toddlers to the tetanus and the diphtheria carrier proteins. Thus, the effect on the tetanus and diphtheria immunity of multivalent conjugate vaccines containing tetanus and diphtheria toxoids as carriers needs to be evaluated before such vaccines are routinely implemented.

Adult↗

PubMed1987

Acellular pertussis vaccine: immunogenicity and safety of an acellular pertussis vs. a whole cell pertussis vaccine combined with diphtheria and tetanus toxoids as a booster in 18- to 24-month old children.

An acellular pertussis vaccine principally containing two purified pertussis antigens, filamentous hemagglutinin and lymphocytosis-promoting factor, combined with diphtheria and tetanus toxoids was compared to conventional diphtheria-tetanus toxoids-whole cell pertussis for adverse effects and serologic responses in a group of 120 children who were from 18 to 24 months of age. Three vaccinations at 2, 4 and 6 months of age with diphtheria-tetanus toxoids-whole cell pertussis had been administered previously. Adverse effects occurred more frequently with the diphtheria-tetanus toxoids-whole cell pertussis than with diphtheria-tetanus toxoids-acellular pertussis vaccine. Fever occurred significantly more often and to a higher degree in the whole cell pertussis vaccine recipients with a peak difference occurring 6 hours after immunization (P = 0.00008). Local swelling, redness, warmth and tenderness at the injection site also occurred significantly more frequently following whole cell pertussis vaccination. No major sequelae were noted in either group. The antibody responses to lymphocytosis-promoting factor were similar for the two vaccines. The diphtheria-tetanus toxoids-acellular pertussis vaccine produced significantly lower pertussis agglutinin titers (P = 0.00001) but significantly higher antibody to filamentous hemagglutinin (P = 0.05) and to diphtheria (P = 0.03). The protective role of antibody to pertussis agglutinins vs. filamentous hemagglutinin and lymphocytosis-promoting factor continues as a central issue in the quest for a new pertussis vaccine. A clinical efficacy trial is needed.

Agglutinins↗

PubMed2006

Physician compliance with tetanus guidelines for admitted versus discharged patients.

The Advisory Committee of Immunization Practice (ACIP) has established guidelines for tetanus immunoprophylaxis for patients who present to the emergency department (ED) with wounds. We assessed physician compliance with these guidelines for admitted versus discharged patients. The data in this study comes from one institution involved in a recently published prospective observational study that was conducted at 5 university-affiliated hospitals. Of 400 patients enrolled, 65/397 (16.3%) did not receive tetanus immunoprophylaxis in accordance with ACIP guidelines. Emergency physicians were less likely to adhere to the ACIP tetanus guidelines when admitting patients to the hospital. Of patients discharged, (89%), 292 of 325 were treated in accordance with ACIP guidelines compared with 39/71 (55%) of admitted patients (P < 0.001). Admitted patients were also more likely to sustain tetanus-prone wounds. Despite a propensity to present with tetanus-prone wounds, patients admitted to the hospital were less likely to receive tetanus immunoprophylaxis in accordance with ACIP guidelines.

Adult↗

PubMed1996

Immune response in mice following immunization with DNA encoding fragment C of tetanus toxin.

Tetanus toxin is a potent neurotoxin synthesized by Clostridium tetani. Immunization with fragment C protein, the nontoxic C-terminal domain of tetanus toxin, will protect mice against lethal challenge with tetanus toxin. A synthetic gene encoding fragment C (tetC) had previously been shown to express high levels of fragment C in Saccharomyces cerevisiae. A plasmid, pcDNA3/tetC, which encodes the synthetic tetC gene expressed under the control of the human cytomegalovirus major intermediate-early promoter/enhancer region, was constructed. Expression of fragment C was observed in eukaryotic cells growing in vitro following transfection with pcDNA3/tetC. The immune response induced by intramuscular immunization with pure pcDNA3/tetC DNA was evaluated in a murine model. Anti-fragment C serum immunoglobulin and proliferative responses in splenocytes were observed in BALB/c mice following two immunizations with pcDNA3/tetC. The major immunoglobulin G subclass that recognized fragment C was immunoglobulin G2a, and the stimulated splenocytes secreted high levels of gamma interferon. Immunity to tetanus is dependent on the presence of neutralizing serum antibodies against tetanus toxin. Sufficient anti-fragment C serum immunoglobulins were induced by DNA-mediated immunization to protect mice against lethal challenge with tetanus toxin.

Animals↗

PubMed1998

[Accidental tetanus: clinical and epidemiological profile of inpatients at a university hospital].

INTRODUCTION: Notwithstanding its substantial decline over the last two decades, acquired tetanus is still a serious health problem in most developing countries. Epidemiological transition is often cited as an explanation for this decline, the increase in vaccination coverage of children being the most obvious cause. Few studies have looked carefully at the current epidemiological patterns of acquired tetanus in developing countries. METHODOLOGY: A descriptive, retrospective (series of cases). An acute care 400 - bed university referral hospital situated in a densely populated and highly urbanized area in Southeastern Brazil (Campinas, SP). Patient records the data-base analysed were from the Epidemiological Surveillance Unit of the hospital. RESULTS: In the 57 month period from January 1989 to March 1996 fifty-three patients were admitted with a diagnosis of acquired tetanus. Fifty patients had clinical confirmation, 3 were otherwise diagnosed. Thirty-two (64%) were male and 18 (36%) female. Fourteen (28%) were from rural areas and 36 (72%) from urban. Mean age was 47.6 years, with a median of 49.5. Of the rural patients, 42.85% were under 30 years and 21.42% were over 50, mean age was 36.21 with a median of 34.5. Fewer urban patients were under 30 (13.88%) than over 50 (58.33%), mean age was 52.19 with a median of 54.5. Trismus was the most frequent (92.0%) clinical sign on admittance, followed by abdominal muscular rigidity (84.0%). Treatment measures were uniform and included tetanus immune globulin, antibiotics, surgical debridement of the wound when feasible, diazepan or curare depending on the intensity of spasms. In the second half of the study period, penicillin was replaced by metronidazol. Overall case fatality rate was 20%, in patients that had to receive curare, it was 60%. Hospitalization exceeded 21 days in 56% (28) of the cases, only 10% (5) had a hospital stay of less than 7 days. CONCLUSION: A high proportion of patients were from rural areas, despite an urbanization rate of more than 90%. In the Campinas region there are two different epidemiological patterns of acquired tetanus: a rural pattern, with a higher proportion of younger patients, determined by an inadequate immunization rate and an urban pattern, similar to that found in industrialized countries, with a higher proportion of older patients. RECOMMENDATIONS: There is an obvious need to immunize older individuals in urban areas and young adults in rural areas. The elimination of acquired tetanus will only be achieved with a wider and more intensive adult vaccination program.

Accidents↗

PubMed2007

Risk factors associated with outcome in dogs with tetanus: 38 cases (1987-2005).

OBJECTIVE: To assess the clinical course of disease and risk factors associated with outcome in dogs with tetanus. DESIGN: Retrospective case series. ANIMALS: 38 dogs with tetanus. PROCEDURES: Data were collected from medical records of dogs with tetanus, including signalment; wound characteristics; initial clinical signs; severity of worst clinical signs; time to wound management, antimicrobial treatment, and antitoxin administration; and 28-day survival rate. Statistical analyses were performed to evaluate relationships between the potentially predictive variables and disease progression and outcome. RESULTS: The 28-day survival rate was 77% (among 35 uncensored dogs). The most common initial clinical signs in affected dogs were ocular (n = 18) and facial (11) abnormalities. Nineteen dogs progressed to recumbency with severe muscle spasms, and 14 dogs had high or low heart rate or blood pressure values. Eight dogs died or were euthanized because of complications of tetanus. There was a significant association between younger age and development of more severe clinical signs. Furthermore, a significant inverse relationship between development of severe clinical signs and survival was identified. There was no association between earlier initiation of wound management, antimicrobial administration, or antitoxin administration and either progression of signs or 28-day survival rate. Wound type was not associated with 28-day survival rate. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that younger dogs with tetanus may be more likely to develop severe clinical signs. The prognosis for survival in dogs with tetanus is good if abnormalities in heart rate or blood pressure values do not develop.

Age Factors↗

PubMed1988

Immunity against diphtheria and tetanus in the age group 30-70 years.

In Denmark, childhood primary vaccination against diphtheria and tetanus has been recommended since 1950. No routine revaccinations or general vaccination of adults have been offered. In most other western countries revaccinations are recommended later in childhood. However, death still occurs from diphtheria and tetanus in countries with such vaccination programs although it is generally accepted that protective immunity can be obtained by vaccination. On this basis the immunity against diphtheria and tetanus was assessed in a random sample of 351 subjects in the age range 30-70 years. Diphtheria antitoxin titres were determined by in vitro neutralization technique using VERO cells. 26% had diphtheria antitoxin titres below protective level (0.01 international antitoxin units/ml serum). The highest number of unprotected against diphtheria was found among 30-39 year old women (68%) and 60-69 year old subjects (36%). Tetanus titres were determined by a combination of ELISA technique and an in vivo neutralization assay. 51% were unprotected against tetanus (less than 0.01 international antitoxin units/ml serum). The highest number of unprotected against tetanus was found among 60-69 year old subjects (68%) and especially among females in this age group (77%). To avoid epidemics of diphtheria in the future the immunity among adults must be raised within the coming years. Thus, revaccination must be recommended and high attendance ensured. One revaccination is sufficient only when complete primary vaccination is documented.

Adult↗

PubMed1989

Epidemiology of tetanus in Finland from 1969 to 1985.

During the period 1969-85, tetanus caused the hospitalization of 106 patients (63 men and 43 women) in Finland. 12 (11.3%) of them died, most of the causes of death being unexpected complications during the intensive care. The majority of the patients were more than 50 years old and had not been fully vaccinated against tetanus. There was a clear seasonal variation, most of the cases occurring during the months when there is no snow on the ground. Half of the primary lesions were minor injuries to hands and fingers. Only half of the primary lesions had needed medical treatment and usually the patients had received antibiotics and tetanus vaccination but not immunoglobulin. To diagnose tetanus is more difficult today than previously, because few doctors nowadays encounter tetanus cases and the diagnosis is based entirely on clinical criteria, and because abortive mild forms of tetanus may occur, especially in patients with partial immunity.

Adolescent↗

PubMed1997

A comparison of young and aged populations for the diphtheria and tetanus antitoxin titers in Japan.

The antitoxin levels for diphtheria and tetanus were measured with samples of a young group immunized with diphtheria-tetanus-acellular pertussis combined vaccine and those of an aged group, members of which had not received vaccination in their youth. In the young group members of which had already received basic immunization with diphtheria-tetanus-acellular pertussis combined vaccine, the levels of both antitoxins rose well after injection at 11 to 12 years old with diphtheria-tetanus combined toxoids and remained high until 20 years of age. In the aged group, more than 80% showed antitoxin levels above 0.01 u/ml for diphtheria, while all had levels below that for tetanus, except three persons with confirmed tetanus immunization history. Maintenance of the protective antitoxin levels in the population by vaccination is necessary to prevent outbreaks of infection among unvaccinated or only partially immunized persons.

Adolescent↗

PubMed2000

[Immunity against diphtheria and tetanus in the adult Polish population].

The aim of the study was to evaluate immunity against diphtheria and tetanus in healthy adult population in Poland. For determination of antitoxin IgG antibody, toxoid enzyme-linked immunosorbent assay (Toxoid-ELISA) was used. Serum samples were obtained from different regions of Poland and titrated for diphtheria (n = 2442) and tetanus (n = 827) IgG antitoxin. For calibration of anti-toxins determination, the WHO standard of human diphtheria and tetanus antitoxin was used. About 32% (n = 787) of persons were non-protected against diphtheria (IgG-DTAb < 0.1 IU/ml) and 24% (n = 195) against tetanus (IgG-TTAb < 0.1 IU/ml). In 63% (n = 1528) individuals basic protection for diphtheria and 48% (n = 402) for tetanus (0.1-1.0 IU/ml IgG-DTAb and IgG-TTAb) were observed. Only 5% (n = 127) were fully protected for diphtheria and 28% (n = 230) for tetanus (IgG-DTAb and IgG-TTAb > 1.0 IU/ml). In adults between 30-64 years of age, not vaccinated at least during last 10 years, 43% of persons were non-protected. The study showed insufficient immunity against diphtheria in adults. We indicate booster immunisation for selected group of persons.

Adult↗

PubMedDate not supplied

[A case of cephalic tetanus presenting with opisthotonus].

We report a case of cephalic tetanus presenting with opisthotonus. A 49-year-old man was admitted because of repeated convulsions. The patient was a garbage truck driver known to be alcoholic, who fell down to suffer an injury of the left face two days before the onset of convulsion. Intravenous administration of diazepam and phenytoin partially relieved the convulsions. Anti-tetanus human immuno-globulin was also administered despite absence of typical clinical sign. Six hours later, however, the patient became unable to open the mouth, i.e. lockjaw developed, and the diagnosis of tetanus was made. Additional anti-tetanus human immunoglobulin of 3,000 units and 4,500 units on the next day rapidly relieved the lockjaw, convulsion, and general muscle rigidity without sequalae. The patient showed transient bilateral facial palsy and rotatory nystagmus during the course. Cephalic tetaus is characterized by a history of an injury of the head and a short latency before developing generalized tonic convulsion or opisthotonus. While a typical case presents with lockjaw, our case presented with opisthotonus, presumably because of early systemic lymphatic spreading of tetanus toxin. Early diagnosis and treatment is important to prevent generalized convulsions which are more frequent and sometimes lethal in cephalic tetanus than the common form.

Facial Injuries↗

PubMed2003

Tetanus experience in a public hospital in Western Saudi Arabia.

OBJECTIVE: Tetanus although rare, has not been eradicated and continues to present from time to time. Early diagnosis and management may be life saving. This study aims to evaluate all patients admitted with clinical diagnosis of tetanus in King Abdul-Aziz Hospital Jeddah, Kingdom of Saudi Arabia over the last 3 years. METHODS: All patients admitted with clinical diagnosis of Tetanus in King Abdul-Aziz Hospital and Oncology Center from January 2000 through to December 2002 were retrospectively reviewed and data was analyzed to determine the demographic features, clinical details, management, and outcome of treatment. RESULTS: A total of 11 patients were admitted during this period. All patients were diagnosed in emergency room by clinical examination. Their ages ranged from 22-68 years. The immunization status of these patients was unknown. All of them were males with 4 of them being injection-drug users. Eight patients had a definite history of injury mainly involving the lower limbs. The incubation period ranged from 5-30 days. Nine patients required mechanical ventilation for a period varying from 2-4 weeks. All patients received Tetanus Immunoglobulin with a dose ranging from 500-3000 unit. The spasms were mainly controlled by diazepam infusion with a maximum dose of 480mg/day. Magnesium sulphate was used in 6 patients to control spasms and autonomic dysfunction. Metronidazole was used in addition to benzyl penicillin in 9 patients. Out of the 11 cases 10 were discharged home and only one patient died 6 days after admission. CONCLUSION: Tetanus is still a problem in developing countries. It is a potentially fatal disease, without early medical intervention. Primary immunization and scheduled booster immunization are important preventive measures that have greatly reduced the incidence of tetanus.

Adult↗

PubMed2004

[Function of tetanus immunoglobulin in case of injury: administration often unnecessary].

OBJECTIVE: To calculate the number of tetanus immunoglobulin (TIG) injections given in order to prevent one patient developing tetanus (number needed to treat (NNT)) and the accompanying costs. DESIGN: Functional study. METHOD: The risk of developing tetanus was calculated from the results of a national study on tetanus immunity in the general population of the Netherlands (1995-1996; n = 7715) and from official notifications of tetanus in the period 1984-1996 (n = 30 persons born before 1945). According to current vaccination policy TIG is advised for unvaccinated persons and those with an unclear vaccination status as well as those vaccinated more than 15 years ago. RESULTS: The tetanus risk after injury was estimated at 0.5-2 per million for unvaccinated individuals. Immunity was lowest (< 50%) in men born before 1936 and women born before 1950. The NNT for these groups was a minimum of 530.000. With a mortality of 10% and costs of 20 Euro per TIG injection, the cost of each life saved was found to be a minimum of 105 million Euro. The NNT and cost per life saved were astronomical for those persons born after 1955. CONCLUSION: The current TIG policy is inefficient. Thanks to the success of the National Immunisation Programme it is now justified to limit the administration of TIG to those who are at the highest risk i.e. those who are known to be unvaccinated, women born before 1950 and men born before 1936.

Aged↗

PubMedDate not supplied

Intrathecal therapy in tetanus. A meta-analysis.

OBJECTIVE: --To assess the efficacy of intrathecal therapy with tetanus antibody (antitetanus equine serum or human tetanus immune globulin) in neonatal and adult tetanus using meta-analytical techniques. DATA SOURCES: --Clinical trials identified by searching MEDLINE and by reviewing bibliographies of published articles. STUDY SELECTION: --Studies in English with concurrent controls treated without intrathecal therapy. DATA EXTRACTION: --Data were extracted by one author and verified by the second; conflicts were resolved by discussion. DATA SYNTHESIS: --No major treatment effect was found in neonatal tetanus when all studies were considered. A benefit was suggested for antitetanus equine serum in adult disease, but this finding should be accepted with caution. Subgroup analyses were limited in power. Methodological difficulties in neonatal and adult trials were common and safety has not been established. CONCLUSIONS: --Intrathecal therapy for tetanus with either antitetanus equine serum or human tetanus immune globulin is not of proven benefit and should only be given in the context of well-designed, controlled trials.

Adult↗

PubMed1991

The prevention of tetanus in the elderly.

Tetanus is a rare disease in the United States, which predominantly affects the elderly and who have a lower prevalence of tetanus immunity compared with younger age groups. A large proportion of the elderly have not received primary immunization for tetanus and do not receive recommended tetanus booster immunizations. Although expert panels support immunization of all persons, without an upper age limit, physicians either are unaware of or do not act on recommendations to immunize the elderly. Improved education of physicians and patients, emphasizing a case-finding approach, may reduce the number of tetanus cases in the elderly. Studies are needed to find ways to improve tetanus immunity in the elderly.

Aged↗